Four sounds may be generated during each heartbeat. The sounds are produced by blood turbulence and vibration of cardiac structures due primarily to the closing of the valves within the heart. These four sounds are identified as S1, S2, S3, and S4. S1 is usually the loudest heart sound and is the first heart sound during ventricular contraction. S1 is often described as a “lubb” sound. S1 occurs at the beginning of ventricular systole and relates to the closure of the atrioventricular valves between the atria and the ventricles. S2 is often described as a “dubb” sound. S2 occurs at the beginning of the diastole and relates to the closing of the semilunar valves separating the aorta and pulmonary artery from the left and right ventricles, respectively. S1 and S2 can be easily heard with a stethoscope (“normal heart sounds”). S3 and S4, however, can usually not be heard in the normal heart (“abnormal heart sounds”) of a person over 40 years old. S3, also referred to as “ventricular gallop,” occurs in the early diastolic period and is caused by the ventricular wall distending to the point it reaches its elastic limit. S4, also referred to as “atrial gallop,” occurs near the end of atrial contraction and is also caused by the ventricular wall distending until it reaches its elastic limit.
Heart sounds can be used to augment the diagnosis and to help assess the severity of important types of cardiac disease. For example, after age 40, S3 can indicate congestive heart failure, and S4 can indicate hypertension, acute myocardial infarction, or coronary artery disease. Unfortunately, recent studies have shown that even highly experienced physicians do not reliably detect important heart sounds.
The electrocardiogram (“ECG”) is an important tool for monitoring heart activity and diagnosing heart conditions. The ECG is a recording of the electrical activity of the heart. This electrical activity causes the heart to contract. The contraction in turn causes blood to be pumped throughout the body. This electrical activity is spontaneously generated. As the cells within the heart change from a negative potential to a positive potential (depolarization), the muscles within the heart contract. Conversely, when the cells change from a positive to a negative potential (repolarization), the muscles return to their noncontracted state. The periodic contraction of the heart causes the pumping action. This spontaneous electrical activity typically occurs about once a second. By analyzing a patient's ECG, various cardiac abnormalities, such as ischemia, can be detected.